Healthcare Provider Details

I. General information

NPI: 1457960874
Provider Name (Legal Business Name): WILLIAM J. LIGHTFOOT DDS, MS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2020
Last Update Date: 07/31/2020
Certification Date: 07/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 REED RD STE 127C
COLUMBUS OH
43220-2553
US

IV. Provider business mailing address

5151 REED RD STE 127C
COLUMBUS OH
43220-2553
US

V. Phone/Fax

Practice location:
  • Phone: 614-457-1432
  • Fax: 614-457-1444
Mailing address:
  • Phone: 614-457-1432
  • Fax: 614-457-1444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM J LIGHTFOOT
Title or Position: OWNER
Credential: DDS, MS
Phone: 614-457-1432